Expect Cost Saving Provisions, Other Changes in the FEHB

kevin couch

2 years ago

Earlier this year in its annual “call letter’’ OPM once again emphasized cost-saving steps in the FEHB including: tighter management of prescription drugs, in particular high-cost drugs; financial and other incentives for enrollees to participate in wellness programs; and better coordination of pharmacy and other benefits for enrollees with both FEHB and Medicare. It also told carriers to: cover applied behavior analysis for treatment of Autism Spectrum Disorder if they don’t cover it already; reduce the use of out-of-network services within network hospitals; and begin or increase access to hospice and advance care planning for those critically ill. Several broader changes in the program that the administration raised in its early-year budget plan would require legislation but there has been no movement on those ideas, which have been pending for several years. These include allowing additional plan designs, centralizing purchasing of prescription drugs rather than by individual plan, and allowing plans to charge higher premiums to those who use tobacco or who don’t participate in wellness programs deemed appropriate for them.